By Amanda Anderson, a critical care nurse and graduate student in New York City currently doing a graduate placement at AJN.
Photo by Morrissey, via Flickr.
There I was, orienting to a busy medical ICU, perplexed over a bedpan. You’d think, since I was just graduating from nursing school, that bedpans would be my area of expertise. Critical thinking and vent strategies came easy; how could I possible admit I had no idea how to give a bedpan to a patient?
Frightening, to graduate from nursing school and a competitive externship program without this competency. Somehow, though, every unit I’d experienced offered patient care assistants, or patients who didn’t need this age-old tool. I’d certainly helped patients to the bathroom and cleaned incontinent ones. Despite the barrage of clinical learning, the basics of offering the pink plastic tool hadn’t sunk in.
Paralyzed, I stood with it in my hand, looking at my intubated, awake patient. I’d had the wherewithal to ask the family to step out, but couldn’t figure out which end went first. The horror of my preceptor finding it backwards would end me. Did the pointed end go towards the patient’s back? The larger end toward the feet for better coverage? Why couldn’t I remember?
Somehow, I managed to decide, and with heart racing, I urged the patient: “Turn to the side!” We both grimaced: I grasped the bedpan with one hand and his right hip with the other, while he reached towards the opposite side rail. His body, heavy with fluid, resisted my timid and inexperienced grasp, and he rolled back onto his back, without bedpan.
My preceptor, just passing by, or discreetly watching from her secret post behind the curtain, arrived just as I was about to start my second try. From the opposite side of the bed, she pulled his body towards her and I placed the bedpan where I thought it should go, praying to the ghost of Florence Nightingale that I’d positioned it right.
If it hadn’t already been so, this experience made it clear to my preceptor that, while I was confident in my nursing knowledge, my skills weren’t up to snuff. Instead of choosing a final clinical placement in a med-surg unit or intensive care, I had opted to spend my senior year working in public health. When I decided that I wanted bedside experience before specializing, I figured I’d just pick up what I missed on orientation.
For some reason, understanding when to intubate a patient came easily, but giving a bed bath? Terrifying. In our unit, we had no patient care assistants, and my preceptor’s goal was to teach me how to perform all patient care without any help. “I don’t want you to do everything by yourself all the time; I just want you to know how to do everything by yourself.”
So, we started slow: I’d begin the bath, washing the front, and then I’d call for her help as soon as trouble hit, or I needed to turn my patient over. But before long, I would be finished before she could even come to check on me—bath, turn, primp and all. Soon, bedpans stopped scaring me, and neither did feeding patients, readjusting bipap masks, emptying foley bags, or primping pillows.
A lot of basic nursing tasks are pretty logical to figure out. A bedpan is shaped like a toilet seat; it would be ridiculous to position the narrow end towards the back. Bed baths are actually chances to slow down and fully assess your patient’s every mole, wound, and toenail. They’re also a great chance to chat and make people feel human in a sterile, cold environment. Even intimidating skills like IV insertion can be practiced and learned until they are anxiety-free procedures for both patient and nurse.
But the hardest thing to learn when we’re first starting out is that these tasks of care are not lists to be followed or steps to be taken. In school, we practice them in unison and in the same order, but real life has a funny way of adding unique twists to their course. Flexibility and an ability to tailor each uniform task to a unique patient is part of the process of grasping basic nursing skills.
While delegation of these tasks is sometimes appropriate, we must not avoid them. Nursing at its finest is the stuff of bedpans and bed baths. These are the moments when our patients feel our intentional touch, rest under the gaze of our watchful eye, and know the quality of our care. Years later, I realized that the lesson my preceptor taught me—to be fully self-sufficient—was simply a cover for her belief that the littlest tasks can be the most important.
As a new grad hire, during my first Code Blue, I had a patient poop their pants, rather poop everything! Once we stabilized the patient, had labs, inserted a Foley, and NG Tube and multiple IV fluids, changing and bathing my patient was something I did not feel I was ready to do. Why is the question I still ask today? I look back now and I laugh thinking I could have changed the patients linen, diaper, new chucks, give a bed bath all during chest compressions! Why do we as new grads today dread or not understand how important our nursing skills are. Nursing school should not only teach us how to chart or the pathophysiology of many diseases but also teach us the importance of mastering bed pans and bed baths, along with changing sheets and making sure sheets are folded the right way.
While giving a patient a bed pan, simple assessments can be made, history can be obtained and ultimately make our patients feel comfortable. I am guilty of delegating these tasks to the floor techs, because sometimes they are time consuming. We have to understand that nursing is a hands on profession, and we should never avoid helping or doing our own bed baths, or helping our patients to a bedside commode because it is the best time to really assess our patient. But as new grads we do not always realize how simple the tasks may be, and need to establish a routine, and know how to keep our patients safe, and happy. It all comes with time, but I see that everything in nursing always goes back to the basics.
I agree that all of these skills and tasks are very important and are an excellent opportunity to assess our patients . I don’t agree with the idea that everyone in nursing has to work in med-surg . or do things a specific narrow way because that is the way it has been done before. I went into nursing after having a good position in health care and in other areas. Our nursing atmospheres are often toxic, heck read the posts. Our profession has to drop these sacred cows and let individuals define their own career paths. By the way, giving a patient a bed bath or a bed pan are skills that family members and strangers perform daily without any training. How about if nurses work together for the patients and stop henpecking each other.
I loved this blog and all that it stands for. First and foremost, nursing remains a hands on profession. Some of the “basic” skills that are often delegated to other HCW’s are often our best chance to really assess the patient. Lab work, numbers from machines, and all the other data we have at our fingertips should not be substituted for a good overall assessment and time with the patient.
Lovely post!
I am glad to read an article like this. A grad who will admit that there were basic things she did not know. She handled it well. I agree with the first comment from 3 year grad. I had 36 months straight of hospital and college based nursing school. It was a tremendous education that served me well through many years of med surg., cardiology, operating room, apheresis/lab, and hospice. Once i even had to teach an instructor how to insert a Foley catheter. I do not belieive a BSN makes for safer patient care. It is the person who is safety conscious and a learning environment that produce safe patient care..
HO ho ho! Somehow I am not surprised at not knowing how to do these things. I have always believed that so many new grads who are so focused on management or higher level care, could not do the basic patient care that we old 3 year diploma RNs were drilled on and practically did in our sleep–and then had to show the new grads how to do, since they didn’t learn such things in school. This person DOES surprise me, however, in admitting that they never learned this. What a shame that so many 2 year and 4 year grads do not spend the time in school to learn the basics. And eventually, there will not be any of us old workhorses left. Then what?
I once was precepting a “new grad” who had orders to administer an IM injection for nausea to her patient. She asked if she could get an order for a suppository instead. I asked why she would do that when she clearly had the IM route written. I questioned her on IM route and discovered she had never given an IM injection in all of her nursing clinicals. Needless to say, she gave her first IM under my supervision.
What a great article. Frequently newly graduated nurses do not realize what they don’t know, which many times are the basics. Experienced nurses after years of doing more with less can forget how important the basics still are. Nursing is a science and our care should be evidenced based. We must also remember that we are caring for individuals who respond not only to treatments, but the person providing them..
Adequate staffing allows time for nurses to perform the basics. We must recognize the importance of nursing assessment and nurse-patient bonding that happens during the delivery of basic care.